Provider Demographics
NPI:1346957529
Name:HUDGINS, TONY DAVID (PH D)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:DAVID
Last Name:HUDGINS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-5519
Mailing Address - Country:US
Mailing Address - Phone:580-980-2190
Mailing Address - Fax:
Practice Address - Street 1:1624 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3762
Practice Address - Country:US
Practice Address - Phone:903-892-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13739183500000X
TX44116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist